1. CHAPTER 48 THE PREGNANT PATIENT LISA MAYO, RDH, BSDH

2. Pregnancy  Prenatal care  Supervised preparation for childbirth that helps the mother enjoy optimum health during  Provides the maximum chance for the baby to be born healthy

3. Fetal Development  Normal pregnancy = 40 wks  Premature birth = Prior to 37wks  3 periods 1. First trimester 2. Second trimester 3. Third trimester

4. Fetal Development  First trimester  Embryo highly susceptible to injuries and malformations  Teratogenic effects  All organ systems are forming (organogenesis)  12 weeks = fetus moves and swallows  Oral cavity development Teeth: Tooth buds 5-6wk, initial mineralization occurs 4-5mo  Second trimester  All organs completed, growth & maturation continue  Fetal wt: changes 1oz every 3mo

5. Factors That Can Harm the Fetus  Infections: rubella, rubeola, varicella, HIV, Hep B, syphilis, gonorrhea  Perio d.: pre-term, low birth weight babies  Medications and other drug use (Table 48-1)  Nearly all drugs can pass across the placenta to enter the circulation of the developing fetus  Many drugs have teratogenic effects  Cont’d next slide

6. Factors That Can Harm the Fetus  Meds  Tetracycline Intrinsic staining of teeth  Herbal supplements: efficacy not regulated by FDA  Therapy for HIV Some antiretroviral meds are NOT withheld because of pregnancy Consideration by the mother can be given to withholding the antiretroviral tx 1 st 14 weeks of pregnancy

7. Oral Findings During Pregnancy  Gingivitis  Clinical appearance will vary Shows characteristics of inflamed tissues  Predisposing factors Local irritation & infection because of poor oral hygiene Hormonal changes that may alter the tissue reaction  Microbiology ↑ Prevotella intermedia (NBQ)

8. Oral Findings During Pregnancy  Pyogenic granuloma / Epulis gravidarum / Pregnancy Tumor / Pregnancy granuloma  Benign inflammatory lesion  Isolated, discrete, soft, round enlargement near the gingival margin usually associated with an interdental area  Painless  Color varies w/vascularity  Bleeds readily

9. Pyogenic Granuloma

10. DENTAL MANAGEMENT OF PREGNANT PATIENT

11. Oral Findings During Pregnancy  Enamel erosion  Morning sickness w/ vomiting over extended periods of time  Recommendations Sodium bicarb rinses Sugarless gum after eating (xylitol the best) Gentle toothbrushing – low abrasive tp

12. Radiography  Not done unless necessary  Protection  Lead apron  Thyroid collar  Exposures  Minimum # of films as possible

13. Overall Treatment Considerations  Appointment planning  Frequency: monthly or 3x during 9-mo pregnancy, varies w/ patient needs  Shorter appts best: tire easily, frequent urination, back ache, gag issues, taste alteration  DH appts early in pregnancy  2 nd trimester best for dental tx (NBQ)  Consult w/ OBGYN prior to tx  Clinical care: Table 48-2, p.748

14. Overall Treatment Considerations PATIENT POITIONING  Supine Position: Weight of developing fetus in the uterus bears down directly on the major vessels, aorta, inferior vena cava Vessels are pressed between the spinal column & uterus

15. Overall Treatment Considerations PATIENT POSITIONING  Supine Hypertensive Syndrome Emergency: Patient is lying in supine position. Abrupt fall in blood pressure impaired venous return - pressure of uterus on inferior vena cava loss of consciousness  Emergency Tx Roll the patient over to her left side to relieve pressure of uterus on vena cava

16. Roll to left side!

17. Dental Hygiene Care  Ultrasonic not contraindicated  LA used in moderation  No nitrous 1 st trimester, 2 nd /3 rd = great precaution, length 30min w/O 2 50%

18. Patient Instruction  Emphasis on general health  Anticipatory guidance for child  Dental biofilm control  Prevent perio  Smoking cessation

19. Dental Caries Control  Incidence during pregnancy: rsrch says increase risk for caries not related to pregnancy itself, but indirectly  Contributory factors  Previous neglect  Diet during pregnancy  Neglect of personal oral care

20. Dental Caries Control  Calcium and the mother ’ s teeth  Misconception concerning the withdrawal of calcium from the mother’s teeth and its relationship to dental caries is widespread  Minerals contained in the erupted tooth enamel and dentin are not available, and no removal of minerals can occur by way of the pulp  Minerals are removed from the external surface of the enamel and exposed root surface in the process of demineralization (biofilm, diet, sickness)

21. Dental Caries Control  Fluoride program  Topical solution, gel, varnish after scaling and root planing  Fluoride dentifrice  Pregnant adolescent = comprehensive fluoride plan

22. Special Problems for Referral  Domestic Violence  Identification  Common sites of injury: head, face, neck  Miscarriages, spontaneous/mult abortions, substance abuse, depression, suicide attempts  What to do: provide pt info about intervention programs, ask pt if they want help, police, refer